Abstract
BACKGROUND & AIMS: To assess the impact of pre-admission renin-angiotensin-aldosterone system inhibitor (RAASi) and statin use on mortality following COVID-19 hospitalization in adults with pre-existing diabetes.
METHODS: Retrospective cohort study of adults with diabetes admitted to ninety-nine participating hospitals in the United Kingdom, France and Spain during the first wave of the COVID-19 pandemic. Logistic regression models adjusted for demographic factors and comorbidity were used to describe associations with mortality in hospital or within 28 days of admission and individual or combined RAASi and statin therapy prescription followed by a country level meta-analysis.
RESULTS: Complete data were available for 3474 (42.6%) individuals. Prescribing patterns varied by country: 25-50% neither RAASi nor statin therapy, 14-36% both RAASi and statin therapy, 9-24% RAASi therapy alone, 12-36% statin alone. Overall, 20-37% of patients died within 28 days. Meta-analysis found no evidence of an association between mortality and prescription of RAASi therapy (OR 1.09, CI 0.78-1.52 (I2 22.2%)), statin (OR 0.97, CI 0.59-1.61 (I2 72.9%)) or both (OR 1.14, CI 0.67-1.92 (I2 78.3%)) compared to those prescribed neither drug class.
CONCLUSIONS: This large multicentre, multinational study found no evidence of an association between mortality from COVID-19 infection in people with diabetes and use of either RAASi, statin or combination therapy. This provides reassurance that clinicians should not change their RAASi and statin therapy prescribing practice in people with diabetes during the COVID-19 pandemic.
| Original language | English |
|---|---|
| Article number | 102484 |
| Number of pages | 7 |
| Journal | Diabetes and Metabolic Syndrome: Clinical Research and Reviews |
| Volume | 16 |
| Issue number | 5 |
| Early online date | 11 Apr 2022 |
| DOIs | |
| Publication status | Published - May 2022 |
Bibliographical note
Funding Information:SoH has received educational funding support from Sanofi Aventis, and consulting fees from Eli Lilly and Oviva
This study received the following funding: the Fondation Francophone de Recherche sur le Diabète (FFRD), supported by Novo Nordisk, MSD, Abbott, AstraZeneca, Lilly and FFD (Fédération Française des Diabétiques) – CORONADO initiative emergency grant; Société Francophone du Diabète (SFD) – CORONADO initiative emergency grant; Air Liquide Health Care international. CORONADO initiative emergency grant; Allergan. CORONADO initiative emergency grant; AstraZeneca. CORONADO initiative emergency grant; Elivie. CORONADO initiative emergency grant; Fortil. CORONADO initiative emergency grant; Lifescan. CORONADO initiative emergency grant; CORONADO initiative emergency grant; Nantes Métroplole. NHC. CORONADO initiative emergency grant; Novo Nordisk. CORONADO initiative emergency grant; Sanofi. CORONADO emergency grant; PHRC National COVID-19 Hospitalization and Care Organization Division (DGOS) as part of the Hospital Clinical Research Program (PHRC COVID-19-20-0138). All research facilities are acknowledged for providing research associates and research technicians for clinical investigations pro bono. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
The ABCD nationwide COVID-19 & Diabetes is an independent audit which has received support from Public Health Wales and Novo Nordisk. The contributors to national studies are listed in supplementary material.
With regard to the CORONADO initiative, we thank the sponsor (DRCI, Nantes University Hospital), Clinical Project Manager (Maëva Saignes) and assistant (Jeanne Saunier), Clinical Research Associates (Selma El Andaloussi, Joëlle Martin-Gauthier, Emily Rebouilleau) and data manager (Tanguy Roman). We thank the Communication Manager of l’Institut du Thorax (Vimla Mayoura). We acknowledge all medical staff involved in the diagnosis and treatment of patients with COVID-19 in participating centers. We thank all GPs, specialists, pharmacists and biological laboratories in charge of hospitalized patients for providing additional medical information to our investigators. We thank the Société Francophone du Diabète (SFD) and Société Française d’Endocrinologie (SFE) for disseminating study design and organization, the Fédération Française des Diabétiques (FFD) for participating in the organization of the study. KK is supported by the National Institute for Health Research ( NIHR ) Applied Research Collaboration East Midlands ( ARC EM ) and the NIHR Leicester Biomedical Research Centre ( BRC ).
With regard to the ABCD-COVID-19 national Audit, we are grateful to all the people who collected the data for this study, to Ben Maylor and Joanne Miksza for data template development, and to Melissa Cull of the ABCD secretariat for administrative support. See contributors of the ABCD COVID-19 audit study in supplementary material. We are grateful to all the people who collected the data for this study, to Ben Maylor and Joanne Miksza for data template development, and to Melissa Cull of the ABCD secretariat for administrative support.
SaH reports personal fees and non-financial support from Astra Zeneca, grants and personal fees from Bayer, personal fees from Boehringer Ingelheim, grants from Dinno Santé, personal fees from Eli Lilly, non-financial support from LVL, personal fees and non-financial support from MSD, personal fees from Novartis, grants from Pierre Fabre Santé, personal fees and non-financial support from Sanofi, personal fees and non-financial support from Servier, personal fees from Valbiotis.
Publisher Copyright:
© 2022 Diabetes India
ASJC Scopus subject areas
- Internal Medicine
- Endocrinology, Diabetes and Metabolism
